The first time Annabelle Mighton, age 16, dislocated her knee, she watched it happen in real time.
“There are mirrors everywhere in the dance studio where I practice ballet,” she said. “I saw my left knee shift out of place, then move back into place. It was shocking, but not terribly painful. My knee swelled up and became hard to move.”
Annabelle, who began classical ballet training at age 4, took the injury in stride. She was used to the toll that ballet sometimes took on her body.
“Ice is my best friend,” said Annabelle, a sophomore at Field High School in Brimfield, Ohio.
So are knee braces, joked her mother, TJ Reinhart, who said Annabelle has so many braces that she names them.
Labor Day mishap
The second time Annabelle’s kneecap moved out of its joint, she was having fun at home over the Labor Day 2018, weekend. Annabelle did a cartwheel and when she landed, she dislocated her left knee. This time, her kneecap didn’t move back into place.
“It was the grossest thing I’ve ever seen,” said TJ. “Annabelle was in a lot of pain and needed to go to the emergency room to reset her knee.”
After taking a few weeks to heal, Annabelle resumed her 5-day-a-week dance schedule at the Meneer School of Dance, a pre-professional dance school in Munroe Falls, Ohio. She was even able to perform in the Ballet Theatre of Ohio’s “The Nutcracker” at the Akron Civic Theatre, something she has done for many years.
Ligaments like rubber bands
In July 2019, Annabelle enrolled in the Meneer School’s month-long summer program to train and improve her dance technique. It was during one of those classes that Annabelle’s left knee dislocated for the third time.
TJ received a call from the dance school owner. In the background, she heard Annabelle yelling in pain.
“I agreed to meet them at Akron Children’s emergency room,” she said. “When I got there, Annabelle needed anesthesia so the doctor could move her knee back in place. They told us that Annabelle’s ligaments were like stretched-out rubber bands and her knee might dislocate again at any time without surgery to correct it.”
Dr. Silverio diagnosed Annabelle’s condition as patellar instability. He also noticed her loose jointedness, or ligament laxity. He ordered tests to rule out a more serious condition. During every exam, Dr. Silverio explained treatment options to Annabelle, as well as her mom.
“He looked at me to make sure I understood what he was planning,” Annabelle said. “He made me feel safe. He had a game plan.”
Dr. Silverio’s thoroughness and positivity impressed TJ, too.
“He told Annabelle, “We’re going to get you back to dance,’” TJ said. “Knowing that was the goal gave us confidence.”
They scheduled Annabelle’s surgery for September 2019.
Growing bones, growing concerns
But a few weeks before Annabelle’s surgery, TJ received a call from Dr. Silverio. While reviewing Annabelle’s x-rays, he noticed the growth plate on her tibia (lower leg) wasn’t fused yet. On average, girls’ growth plates close around age 14 to 15. Annabelle was 14 at the time. Dr. Silverio recommended postponing the surgery to give Annabelle’s tibia time to fuse.
In the meantime, he recommended that Annabelle begin physical therapy.
“I surprise some families when I suggest physical therapy before their surgery,” Dr. Silverio said. “The stronger the muscles are prior to a procedure, it may help in the rehabilitation after a procedure. By seeing a physical therapist a few times a week and setting goals, the person is stronger as they ride that wave into surgery.”
For the next 5 months, Annabelle went to physical therapy, which helped her stay mentally focused to return to ballet dancing.
By February 2020, an x-ray confirmed Annabelle’s tibia growth plate had fused. She was ready for surgery.
Surgery goes well
On March 3, Dr. Silverio performed Annabelle’s surgery at the Akron Children’s Hospital Beeghly campus. The outpatient surgery included a soft tissue procedure to reconstruct a torn ligament and a tibia osteotomy, both of which are designed to make the kneecap more stable.
During Annabelle’s recovery at home, she wore a brace, the one named “Jeremy,” and used crutches to get around. She was even able to return to school a few times before the COVID-19 pandemic closures and restrictions took effect.
Annabelle also resumed physical therapy after her surgery. She found that the physical therapy she did prior to her surgery helped her to recover faster from her surgery.
Overcoming any lingering mental challenges
Annabelle has had several post-surgery appointments with Dr. Silverio. She meets with him at Akron Children’s orthopedic location in Boston Heights, which is more convenient to her Mogadore, Ohio, home.
Additionally, Annabelle has returned to dancing 5 days a week. She said she can see now how much her knee was holding her back.
“The fear of hurting my knee was a mental setback,” she said. “It limited me from giving dancing my all and affected my performances. Now, I feel great. My knee feels fine and my mindset feels mentally and physically stronger.”